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General NPI Number Information
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NPI Number | 1578758017
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Entity Type | Individual
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Provider Name | ZIBA AZIM SHIRAZI D.M.D
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Gender | Female
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Dates
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Enumeration Date | 09/07/2007
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Last Update Date | 10/05/2023
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Provider Practice Location Address
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Address Line | 14761 POMERADO ROAD
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City | POWAY
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State | CA
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Zip | 92064
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Country | US
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Telephone | 858-748-5815
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Fax | 858-748-6130
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Provider Business Mailing Address
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Address Line | 13316 LANDFAIR ROAD
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City | SAN DIEGO
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State | CA
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Zip | 92130-0001
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Country | US
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Telephone | 617-699-6314
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Fax | 858-748-5815
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Authorized Official
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Title or Position |
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Name |
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Credential |
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Telephone |
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 122300000X
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Taxonomy Name | Dentist
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License Number | 63749
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License Number State | CA
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